Results of Pancreas-Transplant Registry

Sutherland, David E.R.; Moudry, K. C.; Fryd, David S.

doi:10.2337/diab.38.1.s46

Cited by 49 publications

(14 citation statements)

References 4 publications

(5 reference statements)

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“…In fact, in our current analysis, technical failure was the most common cause of pancreas graft loss, with an incidence of 12.9%. Nonetheless, this incidence compares favorably with the results from the 1980s and early 1990s, when 30% of pancreas grafts were removed secondary to a technical complication (11,12).…”

Section: Discussionmentioning

confidence: 71%

Chronic rejection: the next major challenge for pancreas transplant recipients

et al. 2003

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Section: Discussionmentioning

confidence: 71%

Chronic rejection: the next major challenge for pancreas transplant recipients

et al. 2003

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“…Thus, graft survival rates have been poorer than those of other more established techniques, such as kidney, heart, and liver. The most recent review of the United States Pancreas Transplant Registry reports 1-yr graft survival rates of 70% for the years 1986 to 1989 (20), a distinct improvement over the 46% graft survival reported for the 1129 cases reported between 1982 and 1986 (21).…”

Section: Continuous Ambulatory Peritoneal Dialysis -Cmentioning

confidence: 92%

“…Hyperglycemia impairs aldose reductase action through an as yet unclear mechanism, and aldose reductase inhibitors have been tried with conflicting results in human trials (18,19), non of which used patients with ESRD. Following pancreatic transplantation, with induction of near-euglycemia, preexistent neuropathy does not remit, although further progression may be halted (20,21). It must be kept in mind, however, that uremia may cause nausea, vomiting, and abnormalities of peripheral nerve conduction that mimic diabetic neuropathy, and treatment of uremia should be attempted before assuming that severity of symptoms results from diabetic neuropathy alone.…”

mentioning

confidence: 94%

Diabetic Nephropathy: Management of the end-stage patient

Markell

Friedman

1992

Diabetes Care

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Diabetic nephropathy is currently the leading cause of new patients requiring dialysis in the United States. Management of the diabetic patient with ESRD is complicated by the frequent coexistence of complications affecting other organ systems, including retinopathy, cardiovascular disease, peripheral neuropathy, or autonomic neuropathy, manifested as gastroparesis, diarrhea or obstipation, cystopathy, or orthostatic hypotension. Associated clinical syndromes must be followed and treated, if possible, while preparing the patient to receive renal replacement therapy. Both the clinical condition and the psychosocial environment are key factors in choice of ESRD therapy for an individual patient. Rehabilitation data are best for patients who undergo kidney transplantation, but these data are confounded by the fact that the healthiest patients are referred for this treatment modality. Living, related kidney transplant is the preferred initial choice for the diabetic patient with kidney disease. At most centers, both in the United States and abroad, the cadaveric transplant is the second choice for uremia therapy. At the appropriate institution, the patient with type I diabetes may also be considered for a simultaneous cadaveric pancreas transplant. While awaiting cadaveric transplantation, or if contraindication to transplantation is present (chronic infection, recent malignancy, or severe cardiac disease), diabetic patients with severe impairment of the glomerular filtration rate (less than 10-15 ml/min) are referred for vascular access placement and/or insertion of a peritoneal catheter. The decision regarding the choice of CAPD vs. hemodialysis must be made on an individual basis. Rehabilitation and survival data for these therapies are similar, although technique survival rates for CAPD decline dramatically as time progresses because of infectious complications. In-center hemodialysis has the worst survival and rehabilitation profile, but the sickest, most debilitated patients with the highest number of comorbid conditions tend to be referred for that therapeutic modality. Most studies of rehabilitation were performed before use of recombinant human erythropoietin, and comparison between ESRD treatment modalities will have to be reevaluated now that the drug is routinely used.

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“…Seit der Einfuhrung der Pankreas-Transplantation durch Kelly im Jahre 1967 in Minneapolis sind weltweit ca. 4.000 Bauchspeicheldrusen-Verpflanzungen durchgefuhrt worden [19,20,27].…”

Section: Introductionunclassified

Verlauf der diabetischen Retinopathie bei einem Zwillingspaar 5 Jahre nach Pankreas-Transplantation

Meyer

Zaki

Mennel

et al. 2005

Spektrum Augeheilkd

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Zusammenfassung.Hintergrund: Bei schweren diabetischen Veranderungen kann eine kombinierte Verpflanzung von Bauchspeicheldruse and Pankreas vorgenommen werden.Methoden: In einer retrospektiven Falldemonstration prasentieren wir ein Zwillingspaar, bei dem im Alter von 25 Jahren eine Pankreastransplantation vorgenommen worden war. Bei beiden Patienten lag eine durchschnittliche Erkrankungsdauer der Retinopathie von 5 Jahren vor der Transplantation vor.Ergebnis: Nach erfolgreicher Pankreastransplantation lag bei beiden Zwillingen an je einem Auge eine proliferative diabetische Vitreoretinopathiee (PDVR) Stadium B and am Partnerauge ein Stadium C vor, welche multiple Pars-plana-Vitrektomien erforderten. Beim ersten Zwilling betrug der preoperative Visus 1/50 rechts and 0,05 links welcher postoperativ auf 1/35 and 0,2 verbessert werden konnte. Gleichzeitig wurde die retinale Situation langfristig stabilisiert. Beim zweiten Zwilling war der bestkorrigierte Visus 1/35 rechts and 0,2 links. Nach mehreren Operationen wurde eine stabile Fundussituation erzielt and eine Visusstabilisierung auf 1/35 rechts and 0,2 links erreicht. Zu einer AbstoBungsreaktion des transplantierten Pankreas war es innerhalb der ersten vier postoperativen Jahre nicht gekommen.Schlussfolgerungen: Durch eine verbesserte Operationstechnik bei der Pankreas-Duodenal-Transplantation konnte die Rate an AbstoBungsreaktionen and Transplantatversagen deutlich gesenkt werden. Bei unseren Patienten konnte auch langfristig eine suffiziente Stoffwechsellage and Normalisierung des Glukosestoffwechsels erreicht werden and die Lebensqualitat nachhaltig verbessert werden. Fur eine erfolgreiche Behandlung einer diabetischen Vitreoretinopathie musste die Pankreastransplantation vor dem Auftreten von irreversiblen Veranderungen durchgefuhrt werden. Sollte es gelingen, die Pankreastransplantation zu einer Routineoperation werden zu lassen, sollte der Zeitpunkt fruher gesetzt werden, so dass fiir den juvenilen Diabetiker ein brauchbarer Visus erhalten werden kann. Course of diabetic retinopathy in twins 5-years after pancreas transplantationSummary. Background: A combined transplantation of the pancreas and kidney can be done in severe diabetic circumstances.Methoden: In a retrospective case demonstration we present a twin couple, who received a transplantation of the pancreas at the age of 25. The onset of the diabetic vitreoretinopathy was approximately 5 years in both patients prior to surgery.Results: Ater a successful pancreas transplantation both twins had in one eye a proliferative vitreoretinopathy (PDVR) stage B and in the fellow eye stage C, requiring multiple pars plana vitrectomies. The first twin had a preoperative visual acuity (VA) of 1/50 OD and 0.05 OS, which increased to 1/35 and 0.2 postoperatively, combined with a persisting stabilization of the retinal situation. The second twin had a bestcorrected VA of 1/35 OD and 0.2 OS. Multiple surgeries achieved a stable fundus situation and a gain in vision to 1/35 OD and 0.2 OS. An immunological rejection o...

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Results of Pancreas-Transplant Registry

Cited by 49 publications

References 4 publications

Chronic rejection: the next major challenge for pancreas transplant recipients

Chronic rejection: the next major challenge for pancreas transplant recipients

Diabetic Nephropathy: Management of the end-stage patient

Verlauf der diabetischen Retinopathie bei einem Zwillingspaar 5 Jahre nach Pankreas-Transplantation

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